| Doctor Name: | PRASAD VENKATA KANNAEGANTI |
| NPI Number: | 1114922630 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | N1701 |
| Business Practice Address: | 6331 Boulevard 26 Suite 220 North Richland Hills, TX - 761801590 |
| Business Phone Number: | 8176280284 |
| Business Fax Number: | 8176280288 |
| Mailing Address: | 3315 Colorado Blvd, Suite 102 DENTON |
| State: | TX |
| Postal Code: | 762106884 |
| Phone Number: | 9403201708 |
| Fax Number: | 9405655457 |
| NPI Enumeration Date: | 06/21/2005 |
| NPI Last Update Date: | 12/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | N1701 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |